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Brian, I think the jury is still out. It makes sense to me that given an unknown one should try agonists first but not delay l-dopa if there is significant disability. Do you have data that there is no difference in the onset of dyskinesia regardless of when someone starts l-dopa? Charlie Brian Collins wrote: > > On Wed 29 Oct, Charles T. Meyer wrote: > > Brian, Yen and others, > > > > Under the microscope there is no apparent brain damage from sinemet. > > Nonetheless, I would assume there are some brain changes at the > > receptor sites at least on the molecular level since long term sinemet > > induces dyskinesia. Therefore it would be assumed that it induces a > > change which might be classified as brain damage. From the practical > > standpoint Yen these days PWP usually start off taking a dopamine > > agonist such as mirapex (pramipexole), bromocryptine or pergolide to > > start starting sinemet only if the agonist doesn't relieve symptoms > > thereby delaying the use of and then hopefully the dyskinesia which is > > induced by sinemet. > > > > Charlie > > > > > CHARLES T. MEYER, M.D. > > Middleton, WI > > [log in to unmask] > > > > > > > Hello Charlie, I am disappointed: after all that has been written in these > columns, do you still subscribe to that nonsense about 'delaying the start > of levodopa therapy' > > Regards, > -- > Brian Collins <[log in to unmask]> -- CHARLES T. MEYER, M.D. Middleton, WI [log in to unmask]